Legal name of Applicant:*
Alternate / Partner Contact Name:

Business Name:
Business Start Date:
Business Address:
Business Telephone:
Business Website:
Status of Business:

Amount Requested from Starter Company Plus: $ *
Grant money to be used for :*
Briefly describe the nature of the Applicant’s organization or business including its sector (arts & culture, research, education, etc.) *
Provide an overview of the business.*


Personal Contribution (25% min)

Source #2 (if applicable)

Source #3 (if applicable)

Starter Company Plus

Funding Type*

Funding Type1:
Funding Type2:
Funding Type3:

Funding Status**

Funding Status1:
Funding Status2:
Funding Status3:

Activities Funded

Activities Funded 1
Activities Funded 2
Activities Funded 3
Activities Funded 4

Total Funding

Total Funding 1
Total Funding 2
Total Funding 3
Total Funding 4
I am over the age of 18:
I want to be in the program to:
I am a Canadian citizen (or permanent resident) and a resident of Ontario:
I am prepared to commit to a minimum average of 35 hours per week to running or starting the business while in the Starter Company Plus program:
I am prepared to attend weekly meetings and training sessions for the entire length of the program (4 months). The majority of meetings and training sessions are scheduled on Thursdays, from 12:00 PM to 1:30 PM (exceptions may occur). :
I am prepared to return to the Regional Business Centre for a mentoring roundtable within 6 months following the program end date should I be approved for funding:
I am prepared to provide the Regional Business Centre with financial information, hiring of employees and other business details as requested (this is to ensure that each business experiences growth from taking part in the program). :
I am able to contribute 25% of grant money received (25% of $5,000, meaning $1,250) in in-kind contribution or monetary contribution to the business:
I am not a full time student, nor will I be returning to school:
My business or business idea is NOT part-time or seasonal (i.e: snow plowing):
By agreeing below, as the Applicant or an authorized signing officer of the Applicant, I certify to the Regional Business Centre that the information contained in this Application Form, which includes the supporting documentation submitted herewith, is true and complete in all respects. If the Regional Business Centre discovers that the Application Form contains any material misrepresentation, this Application Form shall be deemed to be withdrawn immediately by the Applicant. I agree to provide any additional information that the Regional Business Centre or its authorized program administrator may reasonably require for the purposes of assessing this Application Form and administering its Starter Company Plus Fund. I am aware that I am required to participate in monthly mentoring meetings for a minimum of six months upon approval of funding. I am also required to report back to the Regional Business Centre detailing revenues, cash-flow, hiring and other business details as requested. *